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Permit • MECHANICAL PERMIT CITY OF TIGARD Illi I <'. COMMUNITY DEVELOPMENT Permit #: MEC2011 -00351 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/26/2011 Parcel: 2S111DD05200 Jurisdiction: Tigard Site address: 15855 SW STRATFORD LP B Project: JACKSON Subdivision: Lot: Project Description: Replacing gas fireplace. • Contractor: TOM BISHOP CONSTRUCTION Owner: JACKSON, HY P & MYRA M FAMILY TR 4578 SE 103RD AVE 620 SW 167TH AVE BEAVERTON, OR 97005 BEAVERTON, OR 97006 PHONE: 503 - 644 -7868 PHONE: 503 - 690 -2525 FAX: 503 - 626 -9138 FEES Specifics: Description Date Amount Gas Fireplace 07/26/2011 $33.39 Type of Use: SF 12% State Surcharge - Mechanical 07/26/2011 $10.80 Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 07/26/2011 $56.61 Occupancy Grp: Stories: Fuel Fuel Types: Natural Gas Gas Pressure: Total $100.80 Required Items and Reports (Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or direct questions to OUNC b calling 503.232.1987 or 1.800.332.2344. ........_ Issued By: Permittee Signature: f 6��� II(4-ke}P-- Call 503.639.4175 by 7:00 a.m. for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. • Approved plans are required on the job site at the time of each inspection. • Mechanical Permit Application :. `..::`. FOR OFFICE USE 4,ONL Y =1 AA** C; ty of Tigard � �O`` Date/By: �� Permit No . r. Received _ .`a SW Hall Blvd., Tigard, OR 9722 ``\\� 09 Plan Review s1 1 //- L d/ 7� 111 i' ;? Phone: 503.718.2439 Fax: 503.598.1960 , v 4 Date/By: Other Permit: t ...- 'T1GA Inspection Line: 503.639.4175 ' O Date Ready /By: Fd See Page 2 for s •' - Internet: www.ti and -or. ov g g C O �ti� Notified/Method: Supplemental Information r °"I'T', ,,.�< sue, �', RG F.EE -HED l E" - ��.. r COR1ME SC UUE — S CIiECILI `T3'RE� F W ST•.. O ORK; _, ._. , , - a ° �"•�'.'� . ^ � � : . , - F: " : , ^ s',.. - `'� u� -. . . 4a fir.^ - ate , Fe �. � , x'.'N,= . , ,. „ v,..�, ...�.- .,.-. ,,�`. � - . -, .. .. „ «,. , . - - , ^. ,.,�,,, -, r �� - -� �� Mechanical permit fees* are based on the value of the work ❑ New construction ® Addition /alteration /replacement performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. Value: $ ..; : ,. ,�,. l i `>;.CATECORk" LJ) N o;,rs . ,,, z,> . '.OF', GONSTR GTIONa� -w.. max: : €a .,. .'> • ,, . , , ,n.., . >a, �' �;:„°.-. ,:�:�RESIbENT�12tL�,EQ ENT' /�SY.STENIS�FEES *�>� ® 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist. ❑ Multi - family ❑ Master builder ❑ Other: Description Qty. Ea. Total ;� '. .>'•,_ .,., _,,..o ;,.- ,«r ' ;_,- -<= Heating /cooling: �,, .,,n " JO E, - ' -' -- . ND'rL "OCATION > � .... ...»..: � >� .,..�...- ....�,,. ..»,'> ., .,zm.. ,,.�• .�.'s,`�x .�.:•_, Air conditioning Job site address: 15855 SW Stratford Lp (requires site plan showing placement) 46.75 Furnace 100,000 BTU (ducts /vents) 46.75 City /State /ZIP: Tigard, OR 97 Furnace 100,000+ BTU (ducts /vents) 54.91 Suite/bldg. /apt. no.: B Project name: Jackson Heat pump (requires site plan showing placement) 61.06 Cross street/directions to job site: SW 88 Ave Duct work 23.32 Hydronic hot water system 23.32 Residential boiler (radiator or hydronic) 23.32 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 46.75 Subdivision: Lot no.: Flue /vent for any of above 23.32 Other: 23.32 Tax map /parcel no.: Other fuel appliances: ,.<._ ' ,V DESCRI N F O K;,, ` j ,f .1,..,, .., W ater heater Replace gas fireplace Gas fireplace 33.39 513 r ja Flue vent for water heater or gas fireplace 23.32 Log lighter (gas) 23.32 Wood /pellet stove 33.39 Wood fireplace /insert 23.32 ?' Chimney /liner /flue /vent 2 e � °< , F'RO PER7'.Y, O �:<> • fir; = F <�` „:,:;�r,.,t: <.y....._ ���� , s 23.32 Other: 23.32 Name: Myra Jackson Environmental exhaust and ventilation: Address: 620 SW 167 Ave Range hood /other kitchen equipment 33.39 City /State /ZIP: Beaverton, OR 97006 Clothes dryer exhaust 33.39 Single -duct exhaust (bathrooms, Phone: (503)690.2525 Fax: ( ) toilet compartments, utility rooms) 23.32 ;_ >; `z� ®_ APPLICANT::. � �>N ' GONTA < :� %'sty.. r^�� Attic/crawlspace tans 23.32 Po _ �a?:�n , �.... ° -��. � yG� ,a�.,;._ G"P� P'ERSO]V� ., p Business name: Tom Bishop Construction LLC Other: 23.32 Fuel piping: Contact name: Tom Bishop $14.15 for first four; $4.03 for each additional Address: 4578 SW 103' Ave Furnace, etc. Gas heat pump City /State /ZIP: Beaverton, OR 97005 Wall /suspended/unit heater Phone: (503) 644.7868 Fax: : (503.) 352.3444 Water heater Fireplace E -mail: tombishopconstruction @yahoo.com >., ... Range Y ... ��`. _,.,:�e�,•...�, , ..,. :.• ....:- ',. '�> , ' � " ' , .. i( = ^'r, = , . .> Barbecue Business name: Tom Bishop Construction LLC Clothes dryer (gas) Address: 4578 SW 103rd Other: cwt. ; �1V[EC[IANICAG PERMIT�FEES- °;°� a�° � � _ ^ ... ,. -. -mot _ __ ^�`N _ . ; 4 City /State /ZIP: Beaverton, OR 97005 Subtotal Minimum permit fee ($90.00) `o t Phone: (503) 644.7868 Fax: (503) 352.3444 Plan review (25% of permit fee) E' er CCB lie.: 155679 State surcharge (12% of permit fee) la �1,.) TOTAL PERMIT FEE `p©, Authorized signature. /� This permit application expires if a permit is not obtained within 180 ! ° e11� IL/.l days after it has been accepted as complete. Print name: Tom Bishop Date: 7/25/2011 * Fee methodology set by Tri- County Building Industry Service Board I. \ Building \Permiis\MEC- PermitApp doc 09/09/10 440 -4617T (I I /02 /COM /WEB)